Treating epilepsy

Treating epilepsy

Epilepsy is usually treated with medicines. In this way, it's possible for 60 to 70 per cent of those recently diagnosed with epilepsy to avoid fits, with no or minimal side-effects.

Other ways to treat epilepsy include vagus nerve stimulation (VNS), ketogenic diet (now only recommended for children with difficult to treat epilepsy) and surgery.

There are no proven complementary therapies – although stress-relieving treatments, such as aromatherapy and yoga, may be beneficial where stress is a trigger for attacks.

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Monotherapy (single drug therapy)

The most appropriate medicine is administered in the smallest dosage possible. If fits recur, dosage is gradually raised until they cease or the medicine causes negative side effects.

Multidrug therapy

If one kind of medication does not work, a second is added. If the patient's attacks stop, the first medicine is reduced, since most people can be treated with just one type (monotherapy).

If the epilepsy is difficult to treat, it might be necessary to try other medicines. However, if additional medicines prove ineffective, the chance of controlling the attacks is reduced.

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How does the doctor determine the dosage?

The level of medicine in the blood is often measured to determine its effect on the fits. It is important to remember that therapeutic levels (and their side-effects) for epileptic patients are only guidelines and that every patient should be treated individually.

How often should the medicine be taken?

Most medicines given to treat epilepsy are taken in one or two doses a day. No matter how the patient feels, it is important to take the medicine on a regular basis to achieve satisfying results. Forgetting to take it might trigger an attack.

What kind of medicine should be used?

Various medicines are available for different types of epilepsy.

Some types are fairly specific, only having an effect on certain kinds of epilepsy – while in other cases, they have no effect or might even raise the risk of attacks.

In complicated cases of epilepsy, it's often a difficult task for the doctor to find the right treatment.

How to keep a diary of attacks

It is vitally important for patients to make a note of the date and intensity of their attacks.

The frequency and severity of fits are the only guidelines to how well a treatment is working. Without this information, it is difficult or even impossible to know whether it is effective or not.

Treatment during pregnancy

Counselling before conception is essential – since for various reasons, it's important to plan the pregnancy in advance.

Some of the older anti-epileptic medications can cause birth defects but the more modern treatments do not appear to have this risk. The risk to the developing baby from its mother
having a severe epileptic seizure is greater than taking the modern medication.
It may be necessary to change from an older type medication to a newer one
before or during a pregnancy.

A supplement of folic acid may reduce the risk of spina bifida in the unborn child. It needs to be taken before pregnancy and at a higher dose than normally recommended (5mg, instead of 400mcg). Women can take the lower dose until they can see their GP for a prescription as the higher dose is not usually available over the counter.

In addition, the need for medication generally increases during pregnancy and the dose has to be raised.

Reducing the medication

If attacks have been successfully controlled for a few years (about five for adults and two to three for children), it's common practice to gradually reduce the amount of medicine taken.

If the attacks recur, it is usually possible to control them by recommencing the medicine.

Patients should never stop taking their medicine without consulting a doctor, due to the risk of increased attacks.

Vagus nerve stimulation

A new technique inserts an electrical impulse device under the skin, near the collar bone on the left side of the neck, to stimulate the vagus nerve that's nearby.

No one knows quite how it works, and most patients still have to take medication. But it can reduce the frequency and severity of attacks.

Ketogenic diet

This was used in the past, when medication was less refined. It consists of a high fat, low protein and carbohydrates diet.

Because of its risks of heart disease long-term, it's no longer recommended for adults.

It should only be used in children under the supervision of a hospital specialist and dietician.

Is an operation possible?

If it's impossible to gain control of the epilepsy using medicine, an operation should be considered. This kind of treatment is normally used in cases of epilepsy of the temporal lobe.

Nevertheless, surgery can only be considered in cases where there is only one focus for the epilepsy, and when it can be removed without any risk of permanent injury (paralysis, speech disturbances etc). This, unfortunately, is only possible in a minority of cases.

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